Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item North Colombo diverticular disease snap shot audit (VISTA study): a collaborative research initiative(The College of Surgeons of Sri Lanka, 2023) Chandrasinghe, P.; Ediriweera, E.P.D.S.; Niriella, M.; Ranwaka, C.; Fernando, A.; Gunawardena, H.; Kumarage, S.INTRODUCTION Diverticulosis and diverticular disease (DD) is a common occurrence in clinical practice in the local setting with a lack of documented literature. A snapshot audit was conducted at North Colombo Teaching Hospital (NCTH) to ascertain the disease burden in clinical practice as a pilot study to assess feasibility and response rate for a nation wide snapshot audit. METHODOLOGY All surgical and gastroenterology units at NCTH were requested to enter the data between 1st January 2022 to 30th of June 2022 on all patients presenting with DD or those detected with diverticulosis during screening colonoscopy. Prospective data collection was done using RedCap© data capturing platform. RESULTS Out of the 8 units invited (general surgery – 5, GI surgery – 1, gastroenterology – 2), 5 units participated (general surgery – 2, GI surgery – 1, gastroenterology – 2); response rate is 62%. A total of 46 patient records (median age- 68 years; range 29- 86; female 51%) were received within 6 months. Of the total 54.3% had symptomatic uncomplicated diverticular disease (SUDD) while 33% were detected with diverticulosis at screening. Only 13% (n=6) required inward care (bleeding – 3, diverticulitis – 2, perforation – 1) and detected using colonoscopy in 4 and CT scan in 2. In the DD group, 20% (6/31) had complicated DD while 80% had Symptomatic Uncomplicated Diverticular Disease (SUDD). CONCLUSION In this pilot study, a majority of the patients with DD presented with SUDD while around 20% came with complicated DD. The response rate from collaborators was satisfactory. The secure online database usage is feasible and will be used for a national level study in the future to assess the disease burden in the healthcare setting in Sri Lanka.Item Implementation of an Online Histopathology Reporting System in the Department of Pathology, Faculty of Medicine, University of Kelaniya(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Hettiarachchi, W.G.; Ediriweera, E.P.D.S.; Mahendra, B.A.G.G.; Liyanage, S.K.; Hewavinsenthi, S.J.D.S.; Ratnayake, R.M.U.S.The Department of Pathology, Faculty of Medicine, University of Kelaniya provides histopathology reporting for the Colombo North Teaching Hospital (NCTH) as an honorable service. The department currently uses a standalone Microsoft access database to generate reports and it has limited data retrieval capabilities. A newer system was required to address the issues faced, mainly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the work was to implement anonline histopathology reporting system that has facility to track the reporting stage, postgraduate evaluation and data retrieval for researches. Every report is attached with a diagnostic code that can be used in research purposes. A web-based application was developed that has ability to capture data at each step from specimen receiving from the surgery theatre until dispatch of reports. The system has developed to easily customizable to different settings. Thus, it has facility to add new reporting templates, anatomical sites, surgical specimens or diagnostic codes to system through web forms. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with option to edit were uploaded enabling quick report generation. It facilitates postgraduate supervision by enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. Mainly open source scripting languages and databases were used to developed the system: PHP, HTML 5, CSS Javascript, Ajax and MySQL. The system hosted on the faculty intranet and available 24/7 from anywhere at the faculty. The system supports both windows and androids operating systems and the system can be accessed in desktop and tablet computers using any commonly used modern web browsers.Item Post war psychological morbidity among internally displaced, married females in Northern Sri Lanka(OMICS International, 2016) Attidiya, D.S.R.; Wickremasinghe, A.R.; Balasuriya, A.; Ediriweera, E.P.D.S.; Manuelpillai, S.; Williams, S.BACGROUND: A three-decade long conflict between the government military and Tamil rebels in Sri Lanka ended in 2009 with the defeat of the rebels. The civilians were the most affected in the war with reports of scant respect for human rights on both sides of the warring factions. OBJECTIVE: To conduct a cross-sectional study to assess the prevalence of psychiatric morbidity among married females in two villages in Northern Sri Lanka that was affected significantly in the last phase of the war. METHOD: All married females in two resettled villages in the Mannar District were interviewed by trained data collectors using the translated K-10 and PSSR-17 questionnaires to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive disorder. All families in these villages were from internally displaced camps where they had been living for more than a year after having been displaced from their homes and having experienced direct war trauma for weeks. Data was collected from 135 married females between March to May 2011 with ethical approval for the study. RESULTS: Criteria for diagnosis of severe PTSD were met in 57% of all participants and all participants had at least mild symptoms of PTSD. The screening tool for depression showed 63% to have significant depressive symptoms. Both depressive and severe PTSD features were present in 24%. Nearly 73% of participants were having either depression or severe PTSD. CONCLUSION: Psychiatric morbidity was high in the post-conflict period, in a highly vulnerable population of married females.Item Mapping the risk of snakebite in Sri Lanka - A national survey with geospatial analysis(Public Library of Science, 2016) Ediriweera, E.P.D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.BACKGROUND: There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. METHODOLOGY/PRINCIPAL FINDINGS: The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. CONCLUSIONS/SIGNIFICANCE: This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region.Item Comparison of hazard of death following surgery for colon versus rectal cancer(Sri Lanka Medical Association, 2016) Ediriweera, E.P.D.S.; Kumarage, S.; Deen, K.I.INTRODUCTION: Prognosis in cancer is usually assessed by use of Kaplan-Meier survival function estimate curves, which reflect survival, or the proportion of patients that will remain alive after a particular event at a given time. By contrast, hazard function represents the proportion expected to be deceased among those surviving at a given time after an event. OBJECTIVES: To evaluate survival and hazard of death, in patients with colon cancer (CC) and rectal cancer (RC), as indices of prognosis. METHODS: Colon and rectal cancer patients who underwent surgical resection with curative intent from 1996 to 2011 were studied. The hazard of death and survival patterns were assessed with Weibull Hazard models and Kaplan- Meier survival function estimate curves. RESULTS: There were 119 CC and 250 RC patients included in the study. Median (Inter-quartile range: IQR) age of both groups was 58 (49 - 66.5) years. The median (IQR) followup time was 30 (12 - 72) months for CC and 30 (13 - 70) months for RC. Both groups were similar in comparison with regard to age (p=0.96), gender (p=0.56), tumour stage (p=0.33), vascular invasion (p=0.69), lymphatic invasion (p=0.33), perineural invasion (p=0.94), degree of tumour differentiation (p=0.38) and preoperative carcinoembryonic antigen levels (p=0.77). CC showed better overall survival compared to RC (p=0.03) with a 5-year survival rate of 72% versus 60% respectively. After curative resection, CC showed a 6% decrease in hazard of death with time compared with RC which showed a 1% increase in the hazard of death with time. CONCLUSIONS: Among patients who underwent resectional surgery, CC had a better prognosis than RC.Item Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka(Sri Lanka College of Paediatricians, 2016) Adhihetty, D.; Kitulwatte, N.C.; Hathagoda, K.L.W.; Weeraratne, C.T.; de Silva, S.; Ediriweera, E.P.D.S.INTRODUCTION: Patient transport remains a necessary facet of today’s health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. OBJECTIVE: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo. METHOD: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1st March 2014 to 1st June 2014 were included in the study. Data was collected using a self-administered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis. RESULTS: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) in-hospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the commonest diagnosis, occurring in 38.5%. The pre-transfer Paediatric Risk Mortality (PRISM) scores had a median of 12, mean of 13.7±7.8 and Q1-8 to Q3-18. The 12 hour PRISM scores, after excluding patients with PRISM scores of less than 5, showed a median of 14, mean of 18.5±11.7 and a ‘p’ value 0.0002. There was no outcome difference between in-hospital vs out-of-hospital transfers based on the Chi squared test. A written summary was available only in 61 (30.5%) patients. CONCLUSION: A rise in the PRISM score after transfer indicates that the patients had deteriorated during the transfer and transfer conditions need to be improved.